The cost of the National Health Service in the United Kingdom now exceeds £l,000m. per year. Ten years ago, when expenditure was less than half this amount, the cost of the Health Service was the source of continued public concern. Cost was "the one aspect of the National Health Service which, since its inception in 1948, has given rise to more critical discussion and controversy than any other single issue". The controversy has now largely died away, and expenditure on the Service is no longer viewed with such alarm or disquiet.
Alcoholism has been a problem for many hundreds of years although the word itself is comparatively modem. Like schizophrenia it has, at various times, been described as a sin, a social problem, a disease and an emotional disturbance. Until recently it stood largely outside the field of public health. Alcoholism has been defined in terms of alcohol's adverse effects on the drinker, his family or society; in terms of getting drunk; in terms of the compulsive nature of drinking and, finally, in terms of specific recognisable physical or psychological symptoms.
It has generally been the policy of OHE, in this series of occasional papers, to avoid controversial topics directly involving the pharmaceutical manufacturers, who still provide much of the finance for our Office. We are departing from the tradition on this occasion partly by accident and partly by intent.
The total expenditure on medicines in the United Kingdom in 1966 was £267 million. Of this £188 million was for medicines prescribed on the National Health Service. The other £79 million was spent by the public mainly for medicines bought without a doctor's prescription. Thus self-treatment still forms an important aspect of medical care, although in terms of cost it accounts for less than half per cent of total consumer expenditure.
Migraine is typical of the sort of ill-defined self-limiting condition which takes up much of the time of general practitioners. It involves no risk of mortality but it can cause acute intermittent incapacity to the sufferer, occurring with little warning and at times which may be inconvenient, socially embarrassing and often costly. Perhaps its nature can be best illustrated by a quotation from Through the Looking Glass by Lewis Carroll, himself a migraine sufferer, ' I 'm very brave really', he went on in a low voice, 'only today I happen to have a headache' (Tweedledum).
During the past Century the general improvement in living standards and the development of modem medicine have eliminated infectious disease as a major cause of mortality in Britain. The life expectancies of the average man and woman have been considerably extended so that the great majority of people now survive to become liable to the chronic conditions associated with advancing age.
The first Office of Health Economics (OHE) disease state booklet, written in 1962, was entitled 'Progress against Tuberculosis' and was published at a time of great optimism among health care professionals involved in the battle against tuberculosis (TB).Effective anti-tuberculosis medications had recently been developed and were in widespread use. The booklet noted that ' ... the use of these drugs, combined with traditional methods of treatment, had opened up the possibility of the final defeat of TB in Britain within 15 years'.
Tolley, K., Morgan, G., Cartwright, R. and Williams, R.
Series on Health
Non-Hodgkin's lymphoma (NHL) is not a single disease entity but covers a complex group of different types of malignancy. They differ in the cells affected, their course and the structures they form in the lymph glands. The unifying feature of the lymphomas as a whole is that they are all cancerous growths of lymphocytes. These are cells of the immune system which are produced from bone marrow and are located within the lymph glands. Lymphocytes are designed to fight infection by either directly producing or helping to produce antibodies.
In April 1991, a radical programme of public health care reform was introduced by the Conservative Government. The avowed intention of the programme was to improve the overall quality of health care whilst simultaneously moderating the growth in costs. Within the general reform package, prescribing in general practice was a particular focus of attention.
'About one in ten patients in acute hospitals at any one time has an infection acquired after admission to hospitals' (DH/PHLS, 1995, pi). This quotation, introducing recent guidance on the control of infection in hospitals, gives us some indication of the size of the problem and the reasons for concern about the risks to health and the demands on scarce resources engendered by potentially reducible hospital acquired infection (HAI).